Nurse Management of Hypertension in Rural Western Kenya

肯尼亚西部农村地区高血压的护士管理

• 批准号: 8234601
• 负责人: Rajesh Vedanthan
• 金额: $ 13.59万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-17 至 2016-07-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8234601
• 关键词: Address; Adult; Africa South of the Sahara; Age; Agency for International Development; Awareness; Biometry; Blood Pressure; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Chronic Disease; Clinical Data; Clinical Investigator; Collaborations; Competence; Country; Development; Development Plans; Discipline; Disease Management; Economic Burden; Educational Curriculum; Effectiveness; Engineering; Epidemiology; Evidence based intervention; Focus Groups; Foundations; Future; Goals; Government; HIV; Health; Health Services Accessibility; Human; Human Resources; Hypertension; Impact evaluation; Improve Access; Income; Individual; Intervention; Interview; Kenya; Knowledge; Medicine; Mentors; Methods; Modeling; Morbidity - disease rate; Nurses; Operations Research; Outcome Measure; Outcomes Research; Patients; Performance; Physicians; Prevalence; Prevention; Primary Health Care; Procedures; Process; Qualifying; Qualitative Methods; Research; Resources; Risk Factors; Rural; Science; Solutions; Structure; Testing; Time; Training; United States; Work; base; career; career development; community based participatory research; cost; design; disease diagnosis; experience; health economics; hypertension control; hypertension treatment; implementation research; improved; informant; innovation; medical schools; mortality; multidisciplinary; primary outcome; professor; programs; skills; tool; usability

DESCRIPTION (provided by applicant): Nurse Management of Hypertension in Rural Western Kenya Cardiovascular disease (CVD) is the leading cause of death in sub-Saharan Africa among adults above age 30. The prevalence of hypertension, a major risk factor for CVD, is increasing over time in sub-Saharan Africa, exerting a significant epidemiologic and economic burden on the region. Without adequate control of hypertension, its health and economic burden will increase drastically in the decades ahead. Well established and evidence-based interventions to manage hypertension exist. However, treatment and control rates are low, due to several reasons including lack of an effective chronic disease management platform, inadequate access to essential medicines, and insufficient human resources. One strategy to improve delivery of hypertension care is task-shifting, in which specific tasks are "shifted" from highly qualified health workers to health workers with shorter training and fewer qualifications. Thus, the overall objective of this project is to utilize a multi- disciplinary implementation research approach to optimize delivery of hypertension care in sub-Saharan Africa, focusing on a task-shifting strategy involving nurse management of hypertension. The candidate, Dr. Rajesh Vedanthan, Assistant Professor of Medicine/Cardiology at Mount Sinai School of Medicine, aims to become an independent clinical investigator specializing in implementation research, in order to optimize the delivery of cardiovascular prevention and treatment interventions in low- and middle-income countries. His career development plan, targeted to this career goal, incorporates a multi-disciplinary program carefully designed to provide an intense, closely mentored, implementation research experience in combination with a structured didactic curriculum. The candidate will conduct the proposed research in rural western Kenya in collaboration with the United States Agency for International Development-Academic Model Providing Access to Healthcare (AMPATH) Partnership. Aim 1 is to evaluate facilitators and barriers to implementation of nurse-based management of hypertensive patients, by conducting a rapid assessment procedure. Aim 2 is to utilize a participatory, iterative, human-centered design process to develop a smartphone-based decision support and integrated record-keeping (DESIRE) tool to be used by nurses for hypertension management. Aim 3 is to conduct an impact evaluation of a pilot program for nurse-based management of hypertension to be implemented by AMPATH. Aim 4 is to estimate the nurse workforce requirements for stable, long-term treatment of hypertension using a needs-based workforce estimation model. The specific aims will be accomplished under the guidance of a multidisciplinary team of mentors and advisors with complementary expertise. The project is guided by the following career objectives: 1) develop expertise in qualitative methods and community-based participatory research; 2) develop competence in management sciences and human performance engineering; 3) acquire skills in advanced biostatistical and impact evaluation methods; and 4) acquire knowledge of the methods of operations research and modeling. PUBLIC HEALTH RELEVANCE: Nurse Management of Hypertension in Rural Western Kenya Hypertension is the leading global risk factor for mortality and the global cost of suboptimal blood pressure is estimated to be nearly $1 trillion over the next decade. This project therefore aims to address a singularly critical health and development issue for low- and middle-income countries. The results of this work will add to the emerging body of knowledge on scalable and sustainable strategies for effectively managing hypertension and related chronic diseases in low- and middle-income countries, as well as resource-poor settings in the USA and other high-income countries.

描述（由申请人提供）：肯尼亚西部农村地区高血压的护士管理 心血管疾病 (CVD) 是撒哈拉以南非洲 30 岁以上成年人死亡的主要原因。高血压是 CVD 的主要危险因素，其患病率是随着时间的推移，撒哈拉以南非洲地区的疫情不断增加，给该地区带来了巨大的流行病学和经济负担。如果高血压得不到充分控制，其健康和经济负担将在未来几十年急剧增加。已有完善且基于证据的干预措施来控制高血压。但由于缺乏有效的慢性病管理平台、基本药物获取不足、人力资源不足等原因，治疗率和控制率较低。改善高血压护理服务的一项策略是任务转移，即将特定任务从高素质卫生工作者“转移”到培训较短、资格较少的卫生工作者。因此，该项目的总体目标是利用多学科实施研究方法来优化撒哈拉以南非洲地区的高血压护理服务，重点关注涉及高血压护士管理的任务转移策略。该候选人是西奈山医学院医学/心脏病学助理教授 Rajesh Vedanthan 博士，其目标是成为一名专门从事实施研究的独立临床研究者，以优化中低收入人群的心血管预防和治疗干预措施的实施-收入国家。他的职业发展计划针对这一职业目标，纳入了精心设计的多学科计划，旨在提供密集的、密切指导的实施研究经验以及结构化的教学课程。候选人将与美国国际开发署提供医疗保健学术模式 (AMPATH) 伙伴关系合作，在肯尼亚西部农村地区开展拟议的研究。目标 1 是通过快速评估程序来评估实施基于护士的高血压患者管理的促进因素和障碍。目标 2 是利用参与式、迭代式、以人为本的设计流程来开发基于智能手机的决策支持和集成记录保存 (DESIRE) 工具，供护士用于高血压管理。目标 3 是对 AMPATH 实施的基于护士的高血压管理试点计划进行影响评估。目标 4 是使用基于需求的劳动力估计模型来估计稳定、长期治疗高血压的护士劳动力需求。具体目标将在具有互补专业知识的多学科导师和顾问团队的指导下实现。该项目以以下职业目标为指导：1）发展定性方法和基于社区的参与性研究方面的专业知识； 2）培养管理科学和人类绩效工程方面的能力； 3）获得先进的生物统计和影响评估方法的技能； 4) 获取运筹学和建模方法的知识。 公共健康相关性：肯尼亚西部农村地区高血压的护士管理 高血压是全球主要的死亡风险因素，预计未来十年因血压不理想而造成的全球损失将接近 1 万亿美元。因此，该项目旨在解决低收入和中等收入国家极为关键的健康和发展问题。这项工作的结果将丰富有关可扩展和可持续战略的新兴知识体系，以有效管理低收入和中等收入国家以及美国和其他高收入国家资源匮乏地区的高血压和相关慢性疾病国家。